AT DEATH S DOOR: AFTERWORD. (In Relational Psychoanalysis Book Series Volume 5) Irwin Z. Hoffman

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1 I. Z. Hoffman 1 AT DEATH S DOOR: AFTERWORD (In Relational Psychoanalysis Book Series Volume 5) Irwin Z. Hoffman One development in my own thinking in the last few years has entailed increased curiosity about the sociopolitical implications of psychoanalytic work (Hoffman, 2009a; 2010; Layton et al., 2006; Tolleson, J., 2009). What are the taken-for-granted values that I am living out in my clinical practice? To what extent is a "normative unconscious" (Layton, 2006) governing the way my patients and I are working together, the goals that we implicitly or explicitly set, and even the ways that we are engaged with each other from moment to moment. Is such awareness and critical thinking conducive to subtle or not so subtle changes in what we do within the constraints of the analytic process? Or are these things so deeply entrenched in my patients and in me that it's impractical to imagine how any changes in attitude or perspective could emerge that would reflect heightened political consciousness and moral sensibility bearing on a transformed sense of fulfillment in life. It's interesting to look at earlier papers to see whether I can find precursors of this interest in the clinical work and clinical theory that they convey or advocate. There are a number of features of this essay, At Death s Door, that I think could be regarded as providing fertile ground for the later development.

2 I. Z. Hoffman 2 First, the emphasis throughout, in keeping with the subtitle of the essay, is on "therapists and patients as agents." I am viewing Manny as responsible for whatever he chooses to do or say, and I am similarly regarding myself as responsible for my choices. To say that is not to deny that both of us are acting in ways that are heavily influenced by our personal histories, by our intrapsychic dynamics, by our interpersonal experience and mutual influence, and, finally, by our embeddedness in a sociocultural surround that shapes every moment of our encounter. But I refuse to regard all of those factors as wholly determining of Manny s or my actions. I feel that there has to be a "space" left that allows our behavior to reflect, not only all of those influences, but also our personal freedom. I think consciousness of our responsibility as participants in the analytic relationship paves the way to raised consciousness about our responsibility as citizens of the world. What I am reacting against when I underscore that dimension of our analytic engagement are very deeply entrenched concepts that reside at the core of the psychoanalytic tradition. In particular I am thinking of concepts such as psychic determinism, free association, and evenly hovering attention (Hoffman, 2006). Psychic determinism, by definition, excludes the factor of individual freedom and will (Rank, 1945, pp ). Free association strips the analysand of his or her responsibility for making judgments about what to say and how to say it. The injunction is not to censor, not to judge, but just to speak of whatever comes to mind, and what comes to mind is not something one controls. In a complementary way, evenly hovering attention entails an injunction directed at the analyst that opposes his or her making judgments about what

3 I. Z. Hoffman 3 is important, what warrants interest, what warrants praise or criticism. The analytic participants, analyst and analysand, are, in effect, turned into complementary parts of a machine. They aren't real people engaged in a human interaction. All of it could be thought of as under the rubric of "technical rationality," with a scientific apparatus treating, operating on, an organism with a disorder. Establishing the humanity of the participants while still engaging in an analytic process is transitional to encouraging reflections on both people's political positions as they are enacted within the analytic dyad and as they are expressed outside the office. I want Manny and myself to struggle with what we mean to each other, with what we have done and are doing with each other, and with the whole quality of our relationship as it evolves over time. I feel Manny didn't "have to" come to my house to deliver that check. I want him to take responsibility for that even as we explore the dynamics of that choice. I, in turn, didn't "have to" say on the phone that I didn't think coming to the house was such a good idea. So it's important that I take responsibility for that. I don t take Manny s later return to the therapy for granted, but see it as his generous contribution to the survival and growth of our relationship. Eventually, we explore his deciding to bring that check to the house, and different meanings emerge over time. When I write to Manny in reply to his angry in which he implies that my interest in him is fake, I am trying to maintain analytic discipline while conveying my perspective as honestly as I can. I've heard it argued that that borders on malpractice because it entails objections to the feelings Manny

4 I. Z. Hoffman 4 expressed based upon their emotional impact on me. In effect, it is argued that Manny is pressured to inhibit his true feeling and its expression to accommodate my sense of vulnerability, allegedly a nonanalytic exchange that violates a tacit analytic contract. My response is that there are no affects that emerge and develop outside of a social context. So whatever Manny feels is context dependent. If I respond to his angry accusations with what I have elsewhere referred to as "that stereotypic, stylized posture of psychoanalytic hyper unperturbed calm" (Hoffman, 2009b, p. 621), what will emerge will not be some kind of pure culture of Manny's conscious and unconscious affective experience, but rather his response to that particular, institutionalized, rather peculiar, psychoanalytically correct stance. Meanwhile, an opportunity would be missed for a genuine, very complex encounter, one that I feel is ultimately deeply engaged and loving on my part. In effect, Manny, via the struggle about the wisdom of his visit, finds some of the personal intimacy with me that he craves and that he came to the house hoping the "extenuating circumstances" would permit. A meaning that seems obvious to me now that I missed or didn't value enough originally, is that, ironically, Manny s bringing that check to my home could be viewed as subversive in that it pushes for a personal encounter with me that is outside of the capitalist ritual of the paid for psychoanalytic session. Had that struck me more forcefully at the time, perhaps my attitude on the phone would have been more generous, although of course, there were other considerations. The whole scene can be treated as an enactment, the multiple meanings of which are eventually explored, at least in part. Appreciating the possible value of manifest

5 I. Z. Hoffman 5 interpersonal influence does not preclude, indeed complements, exploration of relevant history and of the transference-countertransference dynamics. Finally, my includes my imploring Manny to be more open-minded in considering the meaning of my behavior. In effect, I appeal to him to adopt a "constructivist" rather than a "positivist" attitude as he reflects on what I said on the phone and its implications. I have no illusion that such an attempt to persuade and edify will succeed by itself, but it can plant seeds that might bear fruit in the future. Whatever asymmetry of power is optimal for a transformative psychoanalytic conversation, it is accompanied by a more or less conscious undercurrent of mutual identification with respect to the ultimate vulnerability of the participants. When that vulnerability is denied it can fuel subtle abuses of power on the part of the analyst beginning with a refusal to recognize the patient as a fellow caregiver with power to deeply affect the analyst s sense of worth. Manny learns that he matters to me, not only as one who needs my analytic love and expertise, and not only as a source of income, but as one whose affirmative presence and participation can nurture my survival, indeed my thriving, as an analyst and as a person. Traditional psychoanalytic thinking promotes a very one-sided arrangement in which the analyst is always, overtly at least, in the role of caregiver. But as a result the patient is deprived of opportunities to have the more caring and generous aspects of himself or herself recognized and affirmed. Tolleson (2009) writes: So while we have fundamentalized narcissistic needs, and positioned ourselves clinically in relation to those

6 I. Z. Hoffman 6 needs, we have not done the same with morality needs compassion, responsibility, caring for others (with the exception of Klein s essentializing of guilt and the pursuit of love over hate). Samuels (2004) criticizes the standard and reifying psychoanalytic theorizing in which the patient is viewed as an infant whose wellbeing rests on whether it is gratified or failed by the broader society as mother. In a powerful reversal, he suggests we regard the patient as a citizen who is caregiver to the baby-world (p. 199). There is a bond between Manny and myself that is reciprocal and powerful. Our consciousness of our own and each other s mortality and vulnerability is critical to that bond. Awareness of mortality has the potential to promote mutual identification and sense of responsibility for the well-being of the other. But it also has the potential to promote, via denial, hierarchical splitting and abuse of power. The connection between the politics of the analytic relationship and national and international politics becomes clear. Judith Butler (2004) is eloquent and passionate on the interface of intimate interpersonal life and sociopolitical realities. Regarding the vulnerability that is part of bodily life Butler writes: Mindfulness of this vulnerability can become the basis of claims for non-military political solutions, just as denial of this vulnerability through a fantasy of mastery (an institutionalized fantasy of mastery) can fuel the instruments of war. We must attend to it, even abide by it, as we begin to think about what politics might be implied by staying with the thought of corporeal vulnerability itself, a situation in which we can be vanquished or lose others (p. 29). The intra-analytic politics that are seen as governing of the analytic relationship in

7 I. Z. Hoffman 7 At death s door, the foregrounding of the vulnerability of the participants and of their responsibility for each other s well-being, stops short of a politically conscious and critical psychoanalysis because its focus remains the analytic dyad considered outside of the context of the sociopolitical realities in which the process is embedded (Botticelli, 2004). It provides fertile ground, however, for movement in that direction. I and others are called upon to confront and act upon our responsibility, as analysts and as citizens of the world, to embrace that difficult yet I ve come increasingly to believe morally imperative course. REFERENCES Botticelli, S. (2004). The politics of relational psychoanalysis. Psychoanalytic Dialogues, 14, Butler, J. (2004). Precarious Life: The Powers of Mourning and Violence. New York: Verso. Hoffman, I. Z. (2006). The myths of free association and the potentials of the analytic relationship. International Journal of Psychoanalysis, 87:43 61 Hoffman, I. Z. (2009a). Doublethinking our way to scientific legitimacy: The desiccation of human experience. Journal of the American Psychoanalytic Association. 57:

8 I. Z. Hoffman 8 Hoffman, I.Z. (2009b). Therapeutic passion in the countertransference. Psychoanalytic Dialogues, 19: Hoffman, I.Z. (2010). DIscussion of papers by Lynne Layton and Malcolm Slavin at invited panel :Dialectical Constructivism: Existential, Sociopolitical, and Clinical Contexts. Meeting of Division of Psychoanalysis (39) of the American Psychological Association, Chicago, April 23, Layton, L. (2006). Racial Identities, Racial Enactments and Normative Unconscious Processes. Psychoanalytic Quarterly. 75: Layton, L., Hollander, N. C., & Gutwill, S. (eds.) (2006). Psychoanalysis, Class and Politics: Encounters in the Clinical Setting. New York: Routledge. Rank, O. (1945), Will Therapy and Truth and Reality, trans. J. Taft. New York: Knopf, pp Samuels A. (2004). Politics on the couch? Psychotherapy and society some possibilities and some limitations. Psychoanalytic Dialogues, 14: Tolleson, J. (2009) Saving the world one patient at a time: Psychoanalysis and social critique. Psychotherapy and Politics International, 7:

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